Northway, Roger Patrick

Northway, Roger Patrick is an individual health care provider with primary practice located at 13105 W Bluemound Rd Suite 100, Brookfield WI 53005-8046. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Northway, Roger Patrick can be contacted via phone (262) 641-9790.

Contact Information

Primary practice address
13105 W Bluemound Rd Suite 100 Brookfield WI 53005-8046
Phone: (262) 641-9790
Fax: (262) 641-9791
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 477125 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2661123 Wisconsin

Profile Details

NPI number 1053449173
LBN Legal business name Northway, Roger Patrick
Credentials MS LCSW
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053449173 NPPES
Wisconsin MEDICAID 39197200

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